I'm wondering if this is going to be how I keep track of big events from now on; standing next to a stranger's hospital bed, with CNN on the tube and kind of thankful the patient is distracted with world-wide breaking news while I "umm hmm" and scramble around trying to figure out what I'm doing.
Patient #2 had begun to talk about this earlier that morning. "I got MY living will", she told me, nodding at the tube.
"Yeah, I heard this case got a lot of people to go out and . . . do that. Make one. ". (I think making conversation without taking a stand might be a talent of mine. Should I be proud of that? Can I put it on my résumé?).
"Well, I did MINE last year.". She's understandably proud of this. Very "cutting edge".
"I'm not going to put my kids through that. Or my grandkids, either. I don't want NOTHING mechanical on me."
(Here's where you go "uh huh" You're listening, but it's a bit too much to claim you agree or disagree with another person's thoughts about their ideal death. And believe me; they are not interested in your thoughts about your own death. You are a bit fumbly, but also healthy and young. Unless it's you sitting in that bed being interrogated about the color of your pee, you get no say.)
"You know he did something to her." This is a statement.
"That's why he wants her to die. He doesn't want her waking up and telling people. Like he could have hit her over the head or something and if she woke up, she'd tell."
Her eyes are glued to the screen. I listen to her belly- all 4 quadrants. There is nothing wrong with her belly, but I have to document that, that is so.
I will also document "patient speaks clearly". Patient is Oriented x 4 (knows person, place, time, situation). Her eyes are clear (white sclera), she is well hydrated.
(Her eyes are sparkling with passion and dark knowledge. Her skin glistens from blood beating through a heart full of truth).
Her 02 sat is 92 on 2 liters of oxygen/nasal cannula - but how to say she went on a diatribe . . . ? She spoke of something she dreamt or experienced long ago and she and CNN do NOT want to meet in a lost alley anytime soon . . . and did not get out of breath at all? Especially since her lungs on ausculation, sound like sandpaper and spinach quiche gurgling through a garbage disposal?
I mention this to her Real Nurse and we call the respiratory team.
It's patient #1 that actually tells me when Terri's gone.
He says "The Kevorkians are one thing but this here is the far, far other end."
"This here is murder."
His eyes also get documented as "clear".
I have been "um, humming" for a while. And I only began to think of what he was saying later on.
What was he telling me? That assisted suicide is ok, but what happened to Terri Schvia- is not?
This patient has had chronic pain since the mid-80's. He's only 41. He's also a Southern Baptist and fire dept. volunteer. The recent radiology reports say things are not going to get better.
I'm still not sure what he meant.
His pain is a 9.5, five hours after his last dose. He is cheerful and polite, but I don't disbelieve him.
There's no way to document 9.5 There's a button for 9 or 10. I go with 9 because anyone who says "10" is labeled a liar.
(A scale of 1-10, with Ten being the very worst pain you've ever experienced in your life. Does anyone know the worst pain they've ever experienced? Even if it were true, it would be madness to acknowledge.)
CNN has told my patients Terri has died and I've managed to get a vial of dilaudid.
I find the syringe and the needle and I pull 2ml of air into it and then push it into the vial (cause that's how we were taught, while drawing up liquid meds- fill the vial with the right amount of air, push in and then pull back and then the right amount of drug will magically appear in the syringe. Blue-collar physics.)
Except when there is no room to dispel liquid with air, such as in the case with "carbo-jets"- and I blow the sucker up. Literally.
My teacher stops me from wiping the dilaudid off the wall. She needs to find a witness to help her document the stain.
She's going to get another vial and I sit next to the man with 9.5 pain and watch CNN. I tell him I blew up his dilauded- because he used to be an EMT ambulance guy, and I feel he'll appreciate this story Or Not- either way it will distract him.
He laughs and nods and repeats: "That Kevorkian thing is one thing . . . this here is something else." He looks at the T.V., either mesmerized or practicing his visualization/ koo-koo Southern Baptist meets NPR Buddhists techniques.
Patient #3. She doesn't watch television. She denies pain. She denies pain and then she denies it some more. Bowel sounds present, capillary refill < 3. She asks questions that I answer. But then she asks them again. I type in "oriented x 4" because that's true. I document "patient denies pain".
And then physical therapy comes in and moves her around and her eyes are full of tears and after they leave she says "oh, please, please!"
And we get the drug. We get it quick, because we know she needs it. This time a pill- huge and pink. And she can't move to sit up and she panics and I help her sit up and put it in her mouth and she takes a sip of water and she panics again.
"Oh, God! It won't go down!"
And if I were to document this I'd say "patient can speak "clearly" (check) / "white sclera" (check)".
And I say, "it's ok" and I help her sit up. And for some reason this helps.
And I say, "you have to tell us when you are in pain".
And she says "how long will it take for the pill to work?"
And I say just a few minutes.
And she says "I don't want to be a bother".
And I say "You have to be a bother. You have to tell us."
And she says "You mean I have to fuss and cry and carry on?" (and she looks at me, 80 years old and strong and challenging, with anger and disdain- her eyes are clear with white sclera)
And I say, "Yes."
And she deflates, "I don't want to be a hypochondriac".
And I say "You have a fractured rib. You can't be a hypochondriac".
And she says "How did I fall?" And I say "I don't know" – but I kind of do, but I think we need specialists to sort that out.
"You have to tell us when you're hurting so we can help you."